Recalls 10 Flashcards
Label this
What is this. Label the bits
What is the criteria for a normal semen report
What is it called when uss waves have a decreased amplitude due to scattering, absorption or reflection
Attenuation artifact
What is the MOA of Mirabegron
Selective B3 agonist
Think agonist because B agonsits in lungs cause relaxation of muscles
How to work out BMI
weight kg / height m SQUARED
How to work out the maternal mortality ratio
deaths/total x 100,000
RECEPTORS
What type of receptor is oestrogen/progesterone
oxytocin
Nuclear transciption factor
G coupled protein receptor
Where are schiller duval bodies found
Endodermal sinus tumour
What is this
Mycoplasma genitalium
Flask shaped and do not have a cell wall
What type of bacteria is chlamydia
Gram negative
Obligate
Cocco-bacillus
PINK IS NEGATIVE
pink makes the boys wink - STIs
What type of haemolysis do Group A and group B strep do
B haemolytic
What links the innate and adaptive immune systems
Cytokines
What type of prostaglandin is carboprost
Prostaglandin F2a
How manh mitochondrial DNA genes are there
37
Nevirapine MOA
Non-competitive reverse transcriptase inhibitor
What is the craic with HRT and breast Ca
Combined HRT slightly increases risk of breast Ca
If you have had a hysterectomy and can take oestrogen only, there is no increased risk of breast Ca.
VZV immunity levels
if >1.1 then immune
if <0.8 then not immune
Label the conditions
How does cardiac output change in labour
First stage - increases 15%
Second stage - increases 50%
How much fetal cardiac output goes to the kidneys
2-3% as compared to 20% in the adult
What effect does HRT have on the thyroid system
Increases thyroid binding globulin. TBG is what carries T3 and T4
What types of toxins do staph and strep produce
Staph - exo and enterotoxins
Strep - exotoxin
Label these
Label the branches
What does phenylalanine get converted to
Tyrosine
Describe the relationship of the pelvic diaphragm to the perineal spaces
Extra calories required in 1/2/3 trimester
NONE in first
2nd 340
3rd 450
What happens to GH in cushing’s disease
Goes down due to excess cortisol
What are the timings of the emergency contraeptives
Levonorgestrel up to 72h (3 days)
Ullipristal acetate up to 120h (5 days)
Copper IUS up to 120h (5 days)
Which drug given in third trimester causes haemolytic anaemia
Nitrofurantoin
IVF cut off for BMI
Must be <30
What is the blood supply to the round ligament
Sampson’s artery
This is a branch of the inferior epigastric artery
Actions of vitamin C
Collagen production
binds to iron
Promotes hydroxylation in protein synthesis
How many adults in UK have normal BMI
36%
When does urine become main contributer to amniotic fluid
18-20 weeks
What are the following placenta abnirmalities:
Succenturiate lobe
Circumvallate
Velamentous
Succenturiate lobe - separate lobe
Circumvallate - membranes fold back on themselves to create dome shape
Velamentous insertion of cord - cord inserts into the membranes rather than the placenta
ENDOMETRIOSIS
How is it diagnosed?
What are the treatment options? How do these work?
Surgical options?
Pregnancy considerations?
Diagnosis:
- Formally a tissue diagnosis
- Lap on longer gold standard.
- Only perform lap if imaging negative and symptoms remains despite hormoneal treatment
Treatment:
- COCP
- Mirena
- GNRH agonists and antagonists - second line
- Aromotase inhibitors
GNRH agonsits work by initially causing a flare of LH and FSH but then continued use causes desensitisation of the GnRH receptors - ultimately causing a menopause-like state
- Will need small dose oestrogen/progesterone HRT to protect bones
GNRH antagonists work by blocking the GnRH receptors. These can have dose titration and can therefore have fewer side effects than agonists.
Surgical options:
- Cystectomy for endometrioma
- Endometrial lesion removal - deep lesions to be referred to specialist centre
- Hysterectomy
Pregnancy considerations:
- Increased risk of miscarriage and ectopic in first trimester
What is the lateral limit for PLND
What about:
Inferior
Caudal
Superior
Suoeriolateral
Lateral - Obliterated umbilical artery
Inferior - obturator nerve
Caudal - circumflex iliac
Superior - bifurcation of iliacs
Superiolateral - GF nerve
What is the rate limiting step in the urea cycle
Enzyme = carbomoyle phosphatase synthetase
Requires NAG - N acetyl phosphatase
How long does it take from the resting follicle to ovulation on average
300 days
How do the various hormones contribut to milk production
Prolactin - alveolar and mammory development
HPL - mammory gland development
Oestrogen - ductal development. Inhibits secretory properties of prolactin until placenta delivered
Progesterone - alveolar development. Inhibits secretory properties of prolactin until placenta delivered
AFTER BIRTH:
Oxytocin - ejection of milk, caused by contraction
Prolactin - production of milk
What is the most chromosomal common cause of primary ovarian failure
45 XO
1:2500
Renal agenesis, oligohydrmanios, low set ears, limb problems
Potter syndrome
Microcephaly, polydactylyl heart defects, omephalocele, polycystic kidneys
Patau’s
Microcephaly, micrognathia, overlapping fingers with clenched fists, low ears
Edwards
Flu like symptoms, back ache
Then baby born with rash, HSM and jaundice
Most likely cMV
Could be syphilis but also would have
- Hutchinsons teeth
- Saddle nose
- Keratitis (visual problems)
Baby is born then gets meningitis, respiratory distress within 1 week of birth
Early onset GBS
Baby gets meningitis, osteomyelistis and pneumonia from 1 week to 3 months after birth
Delayed onset GBS
Where do the following come from:
Rhabdomyosarcoma
Leimyosacoma
Rhambo - skeletal muscle
Leimyosarcoma - smooth muscle
NEITHER AS EPITHELIAL
What causes red degeneration of a fibroid
Pooling of blood - leading to swelling. Then becomes ischaemic. Appears red
Hyaline - reduced blood flow - leads to collagen deposition. Appears pale
What is the makeup of WBC in %
Neutrophils 40-60%
Lymphocytes 20-40%
Monocytes 2-8%
Eiosinophils 1%
Basophils 0.5%
what attacks bacteria lipoproteins in cervical secretions
Defensins
Cathelicidins
(Also Lysozomes
and IgA)
What is the radiation exposure with a VQ scan
1 mSv
1 year of background radiation
What type of TVS probe used in obese women
Lower frequency curviliear probe
Sievert vs Gray
Gray - absorbed dose Sievert - equivalent dose
what is the CTG paper frequency
1cm per minute
What do the small and large squares on an ECG represent
Small - 0.04 seconds
Large - 0.2 seconds
What are the normal ECG changes in pregnancy
TWI lead 3
Q waves lead 3
LAD
Describe the lines on a partogram
Latent - horizontal
Active - the sloped lines together
Sloped line on left - alert line
Sloped line in right - action line
What do these shapes suggest
A - normal
B - OAB
C - voiding issue
D - underactive detrusor with pressure
E - outlet obstruction
Normal level of fibrinogen in blood
2-4
Risk of PET in prim vs multiparous women who didnt have it in first pregnanacy vs women who did
Prim - 3-5%
Multip (no previous PET) - 1-2%
Multip (previous PET) - approx 20%
MOA neostigmine
Anticholinesterase
Why can diazepam cross the placenta
High lipid solubility
What receptors does midazolam effect
GABA
What in pregnancy can cause decreased drug excretion
Decreased albumin and binding proteins
Indirect action of Warfarin
inhibition of prothrombin 2 (factor 2)
What is the most reliable indicator of DIC
D-dimer or fibrin degredation products
What is the risk of baby developing early onset GBS in this pregnancy if they are GBS positive?
What about the next pregnancy if they are GBS positive or GBS negative?
1/800
1/400 if GBS positive again
1/5000 if GBS negative
How do you interpret the results of a syphilis screen
EIA - antibodies to treponema - DETECTS INFECTION AT SOME POINT. Cannot differentiate. Does not always stay positive for life.
RPR (VDRL) - detect entibodies against cardiolipin which is released by syphilis. Detect ACTIVE INFECTION
TP-PA - antibodies against treponema. Stays positive for life
What is the maximum gestation for woman with diet controlled GDM
40+6
Needs to be born before 41 weeks
Lacy(net like) rash on soles of feel and palms and trunk, Low grade fever and mild joint pain.
slapped cheek appearance on face
Parvovirus B19
Macular rash starting on the face and spreads to trunk. Not affecting palms and soles.
Lymph nodes raised behind ears
Rubella
Vesicular rash appearing on trunk and spreading outward and going stages of macule, papule and vesicles
VZV
Chickenpox
Prodrome of cough, coryzal symptoms and conjunctivitis
Maculopapular rash on face spreadying downwards
Koplik spots
Measles
Generalised rash including palms and soles but not lacy
Syphilis
Cocksackie virus rash
hand foot and mouth - painful and not lacy
What is the most common cause of recurrent miscarriage in terms of uterine malformation
Septate uterus
Give examples of WHO classification for cardiac maternal risk
1:
- Ectopics
- Repaired VSD/ASD
- Uncomlicated vale problem
2:
- Most arrythmias
- Unrepaired ASD/VSD
- Marfans without aortic dilatation
- Rapired ToF
3:
- Marfans with aortic dilatation
- Repaired coartaction
- Fontan Circulation
- HCM
- Mechanical valve
4
- Pulmonary arterial hypertension
- Marfans with severe dilatation
- Severely impaired LV <30%
- Coarctation
